SALT LAKE CITY — Recent data from a prominent health care think tank shows the number of fatal opioid overdoses has appeared to steady between 2013 and 2016, even as the number of those deaths attributed specifically to heroin continued to soar during that time.
In 2016, 600 Utahns died from a fatal opioid overdose, according to a report updated Jan. 31 by the Kaiser Family Foundation that uses underlying data from the Centers for Disease Control and Prevention.
Overall opioid overdose deaths in Utah have lingered right around 600 every year from 2013 to 2016, signalizing a slowdown from the rapid growth of such deaths from 409 in 2007 to 597 in 2013.
But 2016 saw 166 Utahns fatally overdose on heroin, compared to 127 a year before that and more than triple the number who died from the drug in 2007, according to the report. From 2007 to 2012, the number of heroin overdose deaths in the state never reached triple digits, with the final death count falling in the 50s in three of those years, the report indicates.
Opioid experts told the Deseret News that it's not surprising heroin deaths are going up. The trend demonstrates addicts' well-beaten path from prescription painkillers to heroin. According to the Utah Department of Health, 80 percent of people who are addicted to heroin nationwide first became hooked on a prescription drug.
"When they get to a point where they can't get prescription opioids, where they can't afford them, then they're turning to heroin because it's cheaper to get," said health department spokeswoman Jenny Johnson.
Considering the increase in heroin deaths, it's noteworthy the state has been able to stop the bleeding in overall opioid overdose deaths, said Angela Stander, prescription drug overdose prevention coordinator for the department.
"We have done a lot in the past two to three years on the prescribing behaviors of physicians (and) doing a lot of public awareness around the dangers of opioids, etc.," Stander said. "I would say that the biggest thing is social norms have changed. It's now the norm to be apprehensive and take caution (with) opioids, from both the public accepting them and the doctors prescribing them."
Lisa Nichols, community health partnership director for Intermountain Healthcare, agreed that keeping overall opioid overdose deaths steady recently is meaningful, citing a Centers for Disease Control and Prevention report showing 26 states experienced a significant increase in such deaths from 2015 to 2016.
"I think what we can be proud as a state that we're not increasing," Nichols said. "I think we can really attribute that to our state taking this very seriously and having some really collaborative efforts."
But she added there's no reason to be satisfied.
"I really want Utah to be the state where we add a color to that map and say we have a statistically significant decrease in deaths," Nichols said. "We're not seeing that anywhere yet."
Stander said she has heard speculation that moving to help Utah doctors be more cautious in the number of opioids they prescribe can directly lead to an increase in heroin use by desperate patients with no other options, but she disagrees and says no such connection can be concluded from available data.
Health officials and others are careful to educate physicians on how to provide alternative options to patients for whom they have to cut back opioid prescriptions, she said.
Jennifer Plumb, medical director of the Utah Naloxone Association and an assistant professor of pediatrics at the University of Utah, said it is critical for patients that their doctors don't "just cut them off" without a plan in place for how they'll overcome their dependence. Otherwise, she said, "they unfortunately are forced in that direction" of searching out heroin.
Nichols said a large part of Intermountain Healthcare's strategy in curbing opioid addiction and overdoses simply comes down to reducing the amount of pills in a prescription rather than eliminating it altogether.
"We know people can start to build dependence (on) opioids within seven days, so even small amounts that are out there can be really dangerous," Nichols said, adding that in a survey of Intermountain patients, "overwhelmingly people used less than 50 percent of what we prescribe."
Last year, Intermountain Healthcare announced a goal to reduce the number of opioids prescribed for acute pain by 40 percent across its entire hospital system by the end of 2018.
The proposal was one of several ways in which the issue of opioid addiction has gained the spotlight since last year.
A stated goal of Operation Rio Grande, an effort that began in August with the intention of rooting out drug dealing around the downtown Salt Lake Road Home shelter, was to divert addicts from jail and instead find them places in intensive substance abuse treatment programs.
A limited form of Medicaid expansion which officially took effect in November was targeted at 4,000 to 6,000 Utahns who were either homeless, mentally ill or needed substance abuse disorder treatment.
And Salt Lake, Utah, Davis, Weber, Cache and Washington counties have each at least begun exploring plans to sue opioid manufacturers in what they say is an effort to hold those companies accountable for not being forthright about the risk of addiction carried by their products. Lawmakers are also considering passing a resolution urging Utah Attorney General Sean Reyes to directly sue opioid manufacturers on behalf of the state.
Reyes said last month that Utah is one of 41 states involved in combined ongoing civil action against those same companies in the hopes of reaching a settlement, but noted that if "the manufacturers and distributors aren't cooperating," then the state is "ready to pull the trigger" on its own lawsuit.
Stander credited the Utah Department of Health's messaging campaign over the past year for elevating the conversation in a way that has reached doctors, patients and decision-makers. The campaign about the dangers of opioids means people "are being empowered" to talk about it with each other, she said.
"Now anytime you have this conversation, people are aware. Before it wasn't talked about as much. We really want to give people a voice," Stander said.13 comments on this story
Plumb cautioned if the conversation is to continue to enjoy a high profile into the future, Utahns must also learn to talk to each other specifically about heroin addiction, which may be a step further than de-stigmatizing conversations about the risks of pills.
"This state's very challenged when it comes to talking about a needle. … So how are we doing to transition to get awareness going?" she asked. "The substance we're now seeing more and more is illicit, so it's a challenge — a really big challenge. Getting (people) to talk about something they purchased on the street corner from someone they don't know — that's going to be tough."